Birthwort Herbal Remedy Linked To Kidney Failure

Birthwort, an herbal remedy, has been linked to kidney failure and cancer, and is likely to blame for broad kidney disease outbreaks in some areas of the world, according to an article published in Kidney International.

“The big clue was the plant itself,” pharmacologist Arthur Grollman of Stony Brook (N.Y.) University, told USA Today. “Once it was appreciated that it contained a potent kidney toxin and human carcinogen, we could get to the bottom of things.” So-called-medical detectives have found that the centuries-old and popular herbal remedy has caused hundreds of years of illness.

Grollman and his team identified a genetic signature linked to birthwort in cancer and kidney failure, according to the journal of Kidney International, said USA Today. Over 100 years ago, toxicologists discovered the dangerous properties of aristolochic acid, found in the Aristolochia plant family, which includes hundreds of species of birthworts, also known as “Dutchman’s pipes,” explained USA Today.

In 1969, a Croatian researcher found that Aristolochia poisoning might have been involved in unusual kidney failure and urinary tract cancer cases seen in areas of Croatia, Bulgaria, and Romania, said USA Today. Birthwort grew thickly in and around the wheat the farmers there grew and researchers believed, but could not confirm, residents were baking the plant’s seeds into their breads.

Birthwort was again looked at in 1991 after dozens of young women from a “slimming” clinic in Brussels suffered from kidney failure. The outbreak led to warnings and a 2000 New England Journal of Medicine report indicating that about 5% of 1,800 women given the Chinese herb, Aristolochia fangchi (another birthwort species), at a weight-loss treatment developed kidney failure. The announcement prompted a U.S. Food and Drug Administration (FDA) warning about birthwort, mentioning 16 weight-loss products then on store shelves, said USA Today.

In a 2007 Proceedings of the National Academy of Sciences paper, Grollman and his team revealed that the same toxin caused the Balkan and Belgian cases, said USA Today, finding that mutations in certain people matched those of mice poisoned with aristolochic acid. The mutations were changes in the tumor-suppressing gene called p53 and “this magic plant turned out to contain a powerful nephrotoxic (kidney-poisoning) substance with an ability to induce urothelial (urinary tract) cancer” said kidney expert Marc De Broe of Belgium’s University of Antwerp, wrote USA Today

In an upcoming study, Grollman and his team discussed the connection in Taiwan, where some 30% of the population is takes the herb as part of traditional medical treatments and 12% of the population suffers chronic kidney disease. The study shows the same p53 gene mutation, Grollman said, a rare genetic signature, noted USA Today.

Under 1994 “dietary supplement” laws, U.S. manufacturers must keep Aristolochia out of herbal products, following FDA warnings. “Banning the herb doesn’t make everything safe, because the cancer it may have initiated takes decades to develop,” said Grollman. “An important message for Americans is that Congress is inviting similar problems in our country by not holding dietary supplements—which includes herbs—to reasonable standards of safety and efficacy,” said Grollman. “We simply don’t know whether other herbal supplements like Aristolochia are being marketed right now.” In 2009, the U.S. Public Health Service added aristolochic acid to its list of human carcinogens.

As we’ve written, 2/3rd of all Americans take some sort of dietary supplement and Americans spent about $11.8 billion on vitamins and minerals in 2010. While medications undergo safety and efficacy testing in order to receive approval by the FDA for release to market, dietary supplements do not. In the case of supplements, manufacturers must ensure safety, efficacy, and proper labeling.

We’ve previously noted that supplements made from products available on the U.S. market prior to 1994 can be sold with no agency review, including a wide variety currently available. Sellers of products containing substances unavailable prior to 1994, need only advise the FDA and do not require approval to be sold.